A total-laryngectomy patient coughs immediately after swallowing liquids. Blue-dye assessment shows fluid passing through the lumen of the indwelling voice prosthesis, not around it. What is the best first intervention?
Leakage through the prosthesis indicates valve failure from biofilm, debris or device wear. Cleaning may restore closure; persistent central leakage requires prosthesis replacement.
A. Inject filler around the tract: Periprosthetic injection treats leakage around an enlarged tract, not through a failed valve.
B. Immediately close the tracheoesophageal puncture: Closure sacrifices voice and is excessive for routine prosthesis failure.
C. Clean and, if leakage persists, replace the faulty voice prosthesis: Leakage through the prosthesis indicates valve failure from biofilm, debris or device wear. Cleaning may restore closure; persistent central leakage requires prosthesis replacement.
D. Perform oesophageal dilatation without assessment: A stricture can raise pressure but the observed route is central valve leakage.
E. Allow unrestricted thin fluids: This exposes the patient to pulmonary contamination until the leak is controlled.
If dye passed around the prosthesis, evaluate tract length, enlargement, reflux, stricture and recurrence; resizing or periprosthetic management would replace simple valve exchange alone.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
Back to the Section 1 bank